Several lines of evidence have confirmed the association between the syndromes associated with HIV infection and heart disease in humans. Clinically significant congestive cardiomyopathy and echocardiographic abnormalities are commonly found. The first project described in this proposal will develop natural history data regarding the incidence, clinical course, prognostic significance, role of non-invasive evaluation and effects of treatment with anti-viral and immunosuppressive agents on HIV-associated heart disease. This proposal will establish an interdisciplinary cooperative research effort enrolling patients from three District of Columbia academic institutions with diverse patient populations. The research group will contain all the necessary components to study the natural history of HIV-associated heart disease and provide important data regarding the effects of pharmacologic intervention on the development and course of heart disease. Cardiac histopathologic abnormalities in patients with HIV infection have been demonstrated in both post-mortem specimens and endomyocardial biopsy samples. It is not known whether the observed abnormalities are due to 1) direct infection of cardiocytes with HIV, 2) damage from a different infectious agent, or 3) immune-mediated damage of heart cells stimulated by the presence of HIV or other infection. Project 2 of this proposal will evaluate a number of possible mechanisms underlying the development of HIV heart disease.